‘Are we opening a can of worms?’: Community‐based occupational therapists' experiences working with clients with unexpected mental health issues

Abstract

General community occupational therapists (OTs) work with clients experiencing chronic and complex conditions, some living with one or more comorbid common mental health issues (such as anxiety, depression or distress). This study aimed to describe the perspectives of general community OTs of their engagement with clients experiencing mental health issues; their perceptions of the implementation of routine screening in their practice, and the knowledge, skills and support they need to identify and support their clients' mental health needs. Six focus groups were undertaken with general community OTs (n = 21) from three Australian health services in rural, regional and metropolitan settings, between December 2020 and January 2021. Data were analysed using a team-based framework approach. Three key themes were identified: (1) OTs' experiences working with people with mental health issues; (2) impacts of engaging with clients experiencing mental health issues on OTs; and (3) implementing routine mental health screening in general community OT practice. The latter had two sub-themes: (i) identified considerations and (ii) education and system-level support needs. General community OTs frequently work with clients with mental health issues. These experiences impact their practice in multiple ways. This study highlights opportunities for integrating routine mental health screening into general community OT practice and identifies the system and educational development required to support this enhancement to practice. Supporting general community OTs to routinely screen for mental health issues will enhance collaborative client-centred care. Our findings may also have implications for other community-based health professionals and services, particularly those delivered in clients' homes.

Allied health professionals’ experiences and views towards improving musculoskeletal services in the UK for patients with musculoskeletal and co-existing mental health conditions: a qualitative study

“…Although training and advanced knowledge are important factors for enhancing confidence [ 45 ], interestingly a lack of confidence and feeling underprepared was also reported by all participants who had previously engaged in mental health training, including OTs who are already taught at the undergraduate level and have designated roles in promoting mental health [ 31 , 46 ]. Similar findings have also been reported for OTs within the community setting [ 29 ]. These observations suggest that training alone may be inadequate for facilitating effective integration of biomechanical and psychological skills within the MSK setting.…”

“…The findings indicate that AHPs recognise the impact of co-existing MH conditions on the management trajectory of MSK conditions and that integration of psychological skills in parallel to the current biomechanical approach is both favourable and warranted. However, not all expressed an interest towards delivering psychological interventions and challenges to achieving effective integration were equally cited, which were consistent with the existing literature [ 19 , 20 , 29 , 44 ]. These challenges go beyond the need for additional training and knowledge acquisition and may relate to departmental readiness and sub-optimal care pathways at a higher organisational level.…”

“…Fewer studies have explored the perceptions of OTs [ 29 ], even though mental health is a taught component within the OT undergraduate curriculum, and OTs have experience with delivering a range of psychological interventions, such as psychoeducation, time use/occupational balance and skills habit development [ 30 , 31 ]. In light of the increasing role overlap between physiotherapists and OTs, the therapeutic benefits associated by the multidisciplinary approach [ 5 , 32 – 34 ], and the growing body of evidence suggesting the potential effectiveness of the biopsychosocial model in the MSK setting [ 5 ], there is a need to consider the perspectives of both professions to gain a clearer picture about the barriers and facilitators to integrating the management of physical and mental health to enhance MSK services, as well as views on anticipated support needs to improve care.…”